ANCIENT METITTERANEAN MEDICINE

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ANCIENT METITTERANEAN MEDICINE
N. S. ANGELIDES MD, PhD, FRCS, FACA
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Introduction.

• The earliest practice of medicine was theocratic.
  The approach to the disease was magic and priests
  were also considered as doctors.
• Illness was believed to be the action of evil
  spirits.

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ANCIENT EGYPTIAN MEDICINE
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• The historian Herodotus wrote that Egypt is the
  gift of the Nile, meaning that its civilization
  expanded on the soil which was formed by the
  recurrent floods of the Nile.

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Step by step evolution.
Imhotep was the god of medicine in
Egypt

• Egypt became an organized nation about 3000 B.C.
• Medicine as a discipline appeared later when
  Egypt had an ambitious Pharaoh named Zoser. His
  chief minister was Imhotep.
• In the Egyptian writings, Imhotep was presented
  as a physician and was considered as the god of
  medicine in Egypt.

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Medicine in Egypt was associated with religion
and magic.

• All papyri dealt with medicine, gave the aroma
  of supernatural formulae.

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But, Medicine in ancient Egypt was not at all
primitive.

• Some medical papyri were really explanatory.
• Among them, the Edwin Smith Papyrus and the
  Ebers papyrus were the most important.

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In these ancient papyri many case histories were
found!

• In addition, a great number of internal
  pathologies were reported, such as eye diseases,
  diabetes and rheumatism.

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Later on, physicians in Egypt were organized in
hierarchy.

• They gradually formed a distinct profession,
  with the court physicians at the top of the
  hierarchy.

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ANCIENT GREEK MEDICINE.
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Acropolis is the landmark of Ancient
Greece
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The beginning of Greek Medicine.

• The history of ancient Greek Medicine begins with
  Iliad, the Homeric poem, which is considered as
  the oldest written document in Greek.

• Homer

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Diseases were thought to be theocratic, sent by
gods, to punish the mankind.

• In "Iliad" Apollo, the god of light, was
  considered as the disperser of epidemics, one of
  which was spread upon the Greek army before the
  departure to Troy.

• Apollo.

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Asclepius.

• Asclepius, lived in the thirteenth century BC and
  was considered as the Greek god of medicine.
• His teacher was Chiron, the Centaur, who was
  taught medicine by Apollo and Artemis.

• Æsculapius

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The symbol of Asclepius.

• The symbol of Asclepius was a serpent around a
  knotted staff.
• Serpents produced poisons, and had a reputation
  for wisdom as well as the power of renovation.

• A serpent entwined round a knotted staff is the
  symbol of Æsculapius

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Hygia.

• The Greek deity of Health was Hygia, known as
  Salus to the Romans she was considered as the
  daughter of Asclepius and took care of the sacred
  serpents.

• Goddess Hygia.

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Asclepeion The Temple of Asclepius

• Although the history of Asclepius was mixed with
  mythology, solid facts were also present
• These facts were the splendid temples devoted to
  him, which were always built in lovely and
  healthy places.
• These places were visited by sick people, and
  this is why the priests of the temples also
  learned the art of healing.

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?he Asclepeion at Epidaurus

• The chief Asclepeion was at Epidaurus.
• Close to Asclepeion there was a magnificent
  theatre, as well as a stadium built to
  accommodate 20,000 spectators!

• The restored entrance of an ancient Asclepeion

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?he Asclepeion of Cos

• However, the most important Asclepeion was the
  one in the island of Cos, the birth place of
  Hippocrates, who is considered as the father of
  Medicine.

• The Asclepeion at Cos as it is to-day

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Hippocrates, the father of Medicine.

• Hippocrates (460 BC-377 BC), according to
  Mythology, was a descendant of Zeus and
  Hercules from his mother, and a descendant of
  Asclepius from his father .

• Hippocrates

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Demystification of the spiritual medicine The
great step!

• Hippocrates rescued medicine from speculation!
• He did what no physician had ever done before He
  examined the sick carefully, he recorded the
  signs and symptoms of the disease and gave
  emphasis on the evidence than on spiritual
  causes.
• He did not ask "Who is causing a particular
  sickness?" but "how and on what process does
  this particular sickness occur?"

• A Greek stamp with the head of Hippocrates.

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Diagnosis and Prognosis

• Hippocrates always based his conclusions on the
  observations.
• He believed that "the best physician is the one
  who is able to establish a prognosis at the
  bedside, penetrating the present, the past, and
  the future of his patient.

• The lunar crater of Hippocrates.

• Hippocrates in advanced age.

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Observations made by Hippocrates.

• Hippocrates classified diseases into sporadic,
  epidemic, and endemic, and had also separated
  them into acute and chronic.
• He also divided the causes of diseases into two
  classes general, such as climate, water and
  sanitation and personal, such as improper food
  and absence of exercise.

• The famous tree of Hippocrates in Cos as it is
  demonstrated on a Greek stamp.

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Homeric poems as a source of information.

• As mentioned already, Greek heroes in Iliad
  were wounded regularly at the battlefields and
  were in need of medical treatment. This was
  obtained either by the help of the gods or by
  doctors.
• However, many times, the wounded heroes managed
  to solve the problem by themselves!

• Aris, god of war.

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Achilles and wounded Patroklos.

• The picture on the left shows Achilles bandaging
  the wounded arm of his close friend Patroklos
  with a white bandage. (From the British
  Archaeological Museum).

• War injury over Patroklos in Troy.

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Ancient Alexandrian Medicine
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The post Alexander the Grate era.

• When the Empire of Alexander the Great was
  subdivided, the Egyptian share fell to Ptolemy
  the 1st, who founded the Alexandrian Library
  under the direction of Aristotle.

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The School of Alexandria

• Ptolemy gathered a number of educated men in
  Alexandria, organizing a system that resembled a
  University.
• For example, Euclides was the teacher of
  Mathematics, and Hipparchus the father of
  Astronomy.

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Anatomy in Medicine was inaugurated in Alexandria.

• The early Alexandrian doctors described the
  organization of the human body from actual
  dissections, on the basis of the discoveries of
  Aristotle in natural history and in comparative
  anatomy.

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Herophilus and Erasistratus

• Two famous Alexandrian physicians and anatomists
  were,
• Herophilus (335-280 B.C.), and
• Erasistratus (280 B.C.).
• Both took part in the early medical teaching at
  the Alexandria School.

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Anatomical discoveries in Alexandria

• Herophilus made a lot of anatomical discoveries
• He also described the connections between the
  nerves and the brain, recognizing the essential
  difference between motor and sensory nerves.

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Operations carried out in Alexandria

• Herophilus was also a good surgeon he operated
  upon the liver and spleen and had a good
  knowledge of obstetric operations.

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The decline of the medical School of
Alexandria

• A description of the teaching in the School of
  Alexandria was given by Celsus.
• However, the foundation of Empiricism marked the
  decline of the Medical School of Alexandria and
  the destruction of an era occurred.

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Ancient Cypriot Medicine.
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The beginning of Cypriot Medicine.

• The history of ancient Cypriot Medicine started
  at the time of Hippocrates.
• Sources of information were the various
  archaeological findings, the writings of ancient
  Greek philosophers, as well as ancient
  inscriptions.

• Hippocrates

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Onasilos the healer.

• From the inscription of Idalium which is the
  oldest and longest ancient written document found
  in Cyprus, we learned that Stasikipros, the king
  of the town, signed an agreement with a doctor
  named Onasilos to treat, free of charge, all
  soldiers that were wounded in the battles during
  the siege of Idalium by the Persian army. (5th
  century BC.)

• The inscription of Idalium.

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Onasilos, the first military doctor in Cyprus.

• The war ended with an unexpected victory of the
  Cypriot army and the king honoured Onasilos and
  his brothers offering them as a price fields and
  political posts.

• Head of goddess Aphrodite found in ancient
  Salamina, Cyprus

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Apollonius kitiefs.

• Another famous Cypriot doctor was Apollonius, who
  lived in the 1st century B.C. His teacher was
  Zoopiros from Alexandria.
• He was well known for his antidotes to various
  poisons. That is why Mithridates, King of Pontus,
  had asked him to prepare for his sake a general
  antidote, in order to avoid poisoning. This
  preparation was taken in small doses for a
  prolonged period and since then this way of
  treatment was called mithridadism.

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• These are the famous warmers made from
  terracotta.
• They could be applied on almost any surface of
  the body filled with fluid and were very popular
  as a mean of treatment of various diseases.

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Ancient Roman Medicine
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This is the centre of ancient Rome
today
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Romes main source of knowledge was Greece

• Roman philosophy and Roman medicine were borrowed
  from the Greeks, who were well known for their
  philosophy, their arts and their culture.
• On the contrary, the Romans were distinguished
  for their genius laws and their governmental
  status.

Aristotle
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In the earlier times and before the settlement of
Greek doctors in Rome medical care was under the
jurisdiction of the head of the family.

• The father had great powers by the Roman law, and
  he acted as physician as well as judge over his
  family!

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Archagathus

• The first regular doctor in Rome was Archagathus,
  a Greek doctor who began practicing in the city
  by 219 B.C.
• He was very popular, the Roman authorities
  received him favorably and arranged a surgery for
  him

surgical instruments
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The structure of the Roman society made medical
practice in ancient Rome difficult

• The lower classes were poor and the relatively
  small upper classes were tyrannical,
  superstitious, selfish and cruel.

Esculapius
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Later on, the number of doctors was increased,
especially during the reign of Nero.

• Andromachus, as the 1st physician to the Emperor,
  had the title of archiater
• In general, there were two classes of archiaters
  
• archiatri sancti palati, and
• archiatri populares.
• The former attended the Emperor the latter
  attended the people.

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The most eminent doctor of Rome was Claudius
Galen, Greek in origin.

• He went to Rome for the first time in 163 AD.
• Galen had probably influenced the progress of
  medical science by his writings more than any
  other medical writer.
• In his youth he was initiated into the idealism
  of Plato, the realism of Aristotle, the
  skepticism of the Epicureans, and the materialism
  of the Stoics.

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Galen

• Galen was also an admirer of Hippocrates.
• His actions were based on Hippocrates principles,
  and he manage to expand and support his ideas
  and discoveries by new facts and new
  observations.

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Roman doctors had many tools in use.

• Some of these were
• The vaginal speculum (dioptra in Greek)
• The cautery (kauterion in Greek) and
• the various hooks.

A spectacular viginal dilator
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The Romans also used techniques that killed germs!

• Although they did not understand how germs were
  related to the diseases, they boiled their tools
  before using them! 
• And they used "acetum" an antiseptic, to clean
  and wash all wounds.

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Gymnastics, water supply and baths as a medical
tool in ancient Greece and the Roman empire
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Gymnastics in ancient Greece and Rome

• had a very high reputation and were also used for
  medical purposes.

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• The exercises were applied mainly by the Greeks,
  and the baths were applied mainly by the Romans.

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The water supply.

• In ancient Greece, the cities were supplied with
  water from springs.
• The Greek aqueducts were simple channels cut in
  the rock.

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On the contrary in Rome, the water was carried
from a long distance, with magnificent aqueducts.
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Near Tarragona, Spain
The important factor about these aqueducts is
that no machinery was used to pump the water!
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• This is the magnificent Roman Pont Du Diable in
  France.

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and this is the aqueduct system in Segovia,
Spain. A similar one exists in Cavalla, Greece.
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Baths were always very popular in the whole Roman
Empire.
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These are the Baths of Caracalla 
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• Thermae of Diocletian

They could accommodate 3,200 bathers!
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From the medical point of view, baths in Rome
were used for the treatment of various diseases,
and also for physical culture. But their
legitimate use became increasingly limited, and
their abuse promoted the decay of the Roman
Empire.
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In summary

• Great civilizations were developed in the
  Mediterranean region in ancient times, giving to
  this area the reputation of being the Cradle of
  Civilization.
• Medicine had a long history in the Mediterranean.
  It goes back to the ancient Egyptians later on
  to the ancient Greeks, to continue with the
  descendants of Alexander the Great and with the
  Romans.

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• Thank you
• for your attention!